Misdiagnosed Injuries

Being misunderstood is a common problem of life. Just ask your spouse or friends. Being misunderstood and misdiagnosed is also a common problem among runners. Just ask Rich Byrnes.

Byrnes qualified for the 2004 U.S. Olympic Marathon Trials, though he almost didn’t make it to his qualifying race due to a misdiagnosed injury. For two years he was being treated for Achilles tendinitis, but in his runner’s gut he never thought that was the problem. Four doctors later he was finally given the correct diagnosis, an entrapped nerve in the ankle. It was treated in two sessions and he was back to his old fast self again.

Numerous runners can echo Byrnes’s story, many without the happy ending. With all the high tech medical diagnostic equipment at our disposal, why are runners still getting the run around when it comes to injury detection?

Keep An Open Dialogue

According to Lewis G. Maharam, MD, medical director of the Suzuki Rock ’n’ Roll Marathon and New York City Marathon, the problem lies in the dialogue between patient and doctor. "Give a detailed history of your running: include when you first noticed the pain and any recent changes in your routine. If the doctor isn’t listening or fluffs you off in five minutes, chances are you aren’t being diagnosed correctly or responsibly," says Maharam.

He cites a recent case of a female runner who came to him after suffering with shin splints. She had been to four doctors already but the pain was still there. A podiatrist had recommended short orthotics, but that wasn’t helping. The last doctor was suggesting surgery. She didn’t think the problem warranted surgery and was looking for another solution. Maharam asked for a detailed history of the injury, an assessment of her running style, distance, speed, etc., and then examined her orthotics. Therein was the problem. She needed full orthotics, not the half-orthotic prescribed. That correction, plus some stretching exercises, saved the runner from unnecessary surgery. She listened to her gut, the doctor listened to her. A perfect match.

Getting the doctor to listen could be a problem in HMO facilities where tight scheduling follows the less-is-more approach to patient-doctor relationships. In this situation, try to obtain a referral from the primary care doctor to a sports medicine doctor. If the primary care doctor gives a diagnosis that you aren’t happy with, insist on seeing a specialist. Don’t fall under the spell of Doctor as God. If you’re not satisfied with the answers, voice your opinion.

Cathy Fieseler, a sports medicine doctor and ultramarathoner, suggests that misdiagnosed injuries sometimes have to do with the doctor’s level of expertise. "I see a lot of runners and because I am a runner I understand what they are saying and most likely have experienced their pain. If the doctor isn’t a runner or hasn’t a basic knowledge of sports medicine, I don’t think they can give an accurate diagnosis," she says. "Chances are they won’t ask the right questions and will miss a critical piece of the puzzle."

Be cautious, however. It is reported that some sports medicine doctors advertise that they are runners just to get the business. Maharam suggests asking the doctor about special training in sports medicine and whether they ever volunteer at races as the appointed sports doctor. Make sure you are getting the best of both worlds and not a doctor masquerading as a runner.

Stick With A Winner

Once you’ve found your soul mate in a doctor, stay true. Build a foundation based on trust and a solid medical history. When Rod DeHaven developed ankle pain last year, his trusted physician had left town. He went to another doctor but wasn’t pleased with the diagnosis of his injury. "I didn’t feel he was as aggressive in finding a cure as my other doctor," says DeHaven. After months of physical therapy, he sought another opinion. That doctor was more thorough and recommended an MRI of the area. After ruling out any tears or fractures, he suggested orthotics. Within a short time the pain subsided. "Things would have turned out differently if I had seen that second doctor first," says DeHaven.

Looking back, DeHaven says he should have immediately looked for a replacement doctor that he could trust and with whom he could build a new relationship when his former doctor left. As an elite competitive runner, he needs to know who to turn to when an injury strikes. "Knowing who to call when trouble rears its ugly head might help alleviate the anxiety over an injury and save time in the long run," says DeHaven.

Understanding the Biomechanics of Running

With an average of 1,000 foot strikes per mile, a slight biomechanic abnormality can lead to a serious injury over time, potentially starting a rippling affect with referred pain and symptoms. Fieseler is a big believer in understanding the biomechanics of running in order to give an accurate assessment of the injury. "By the time I see a patient, they are complaining about a symptom, not the problem. It’s my job to ask the right questions and trace the symptom to the problem," explains Fieseler. "It’s a bit like being Sherlock Holmes."

According to Fieseler, iliotibial band syndrome is a classic case of a misdiagnosed injury. Runners come in and complain about pain in the outside of the knee and assume it is an IT problem. "The symptom may be pain in the knee area but the problem is with the hip," says Fieseler. "A good doctor looks at everything."

Heed Advice

If you trust your doctor, do as he says. Too many runners are anxious to get back on track and cut recovery time short, only to exacerbate the injury and make it worse. This isn’t a misdiagnosed injury, it is a misdirected runner.

Both Maharam and Fieseler concur that the only time they tell a runner not to run is if there is a stress fracture or fracture involved. They may tell a runner to take it easy and back off, though what does "taking it easy" mean? Doctors need to spell it out in most cases, whether it means no speed workouts, no hill work, no racing or just cutting back the weekly mileage. Fieseler was working with a patient who was training for the Marathon Trials. She complained of ankle pain but the X-ray didn’t show a fracture, although Fieseler suspected one was in the making. She put her in an ankle brace for two weeks and said no running but swimming and biking were allowed. The patient started to feel better, so ignored the doctor’s advice and never kept the two-week follow-up appointment. The pain came back worse than before and by the time she went to see the doctor she had fractured her fibula and tibia.

Maharam concurs that runners can be their own worst enemies if they go back to their routine too fast. "Once you trust your doctor, do as you are told," he advises. Runners who fall into the ‘get back too soon’ category can cause their own misdiagnosed injury by not listening to the doctor’s advice and then down the road feeling more pain and going to another doctor. They blame the original doctor for a misdiagnosis when in reality they didn’t listen and aggravated the condition.

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